What is Suspension Trauma?

Suspension trauma, also known as harness hang syndrome and orthostatic intolerance, occurs after
a worker has fallen into a fall arrest harness and is suspended in a hanging position until rescue
arrives. When hanging in a fall harness, the leg straps support the body’s weight. During this time,
the leg straps of the fall protection harness crush the femoral arteries on the inside of the legs,
cutting off blood circulation.
Additionally, when the leg muscles are relaxed, veins in the legs can expand dramatically (known as
vasodilation). Because the leg muscles are not being used to stand up, they are not contracting and
therefore not preventing the veins from expanding. This lack of constriction from the leg muscles
allows blood to gather in the legs rather than returning to the heart and lungs for recirculation, an
effect known as venous pooling. Without constraint from the leg muscles, the expansion of blood
veins in the legs can result in a 20 percent loss in blood circulation.
The loss of circulation causes the heart to work harder to keep the brain and vital organs supplied
with blood. This results in nausea, unconsciousness, and a drop in blood pressure and heart rate. This
part of suspension trauma is the onset of circulatory shock.

The Body Chemistry of Suspension Trauma

When blood pools and becomes trapped in an extremity, the blood can no longer deliver oxygen from
the lungs. To continue to produce energy to sustain life, the cells in the extremity undergo anaerobic
respiration (without oxygen). During anaerobic respiration, glucose (blood sugar, C 6H12O6) breaks
down in half into lactic acid (C3H6O3) in a process known as lactic acidosis

Without blood circulation in the legs, the lactic acid builds up in the stagnant blood. This buildup of
acid-blood is then released when the worker is brought down and circulation restored. High levels of
acid flooding the body can overwhelm the kidneys, liver, and even result in heart failure.

Trauma Straps
Fortunately, there is a simple solution to protect against suspension trauma: personal protective
equipment known as trauma straps. Trauma straps are a pair of straps, one with hooks in it and the
other with loops for the hooks to attach to. They are coiled up in pouches and attached to the fall
harness at the hips. When a worker falls and comes to rest, he would uncoil the straps, hook them
together, and brace his weight against the straps. This allows the fallen worker to stand up in his fall
harness, utilizing his leg muscles, taking weight off of his arteries, and restoring blood circulation
until help arrives.
Because of this, it is important to have trauma straps on all fall protection harnesses. Unfortunately,
some workers believe that hip pouches get in the way of tool bags or other equipment, and so they
remove the trauma straps. Also, many fall protection equipment companies manufacture their fall
protection harnesses standard with trauma straps but, due to the wide variety of harness
manufacturers and harness designs, not all models come with trauma straps as a standard feature.

Rescue
If a worker falls and the force of the impact is great enough, the worker may pass out. In this case,
the worker would not be able to deploy the trauma straps and will be left hanging in his harness,
without leg support, until help arrives. Because of this, it is important to have a rescue plan in place.

In a technical bulletin on suspension trauma, OSHA identified that suspension trauma could be fatal
within 15-30 minutes of the initial fall. This 15-30-minute window is what OSHA refers to when it
says that a fall protection plan must contain plans for a "prompt" rescue. It is also important for
rescuers and those writing fall plans to understand the hazards present after a worker has been
brought down, from the lactic acid built up in the legs.

Conclusion
Suspension trauma poses a serious risk to workers at heights. The physiological response to the
known symptoms of suspension trauma confirms that this hazard can be lethal. However, there are
simple steps that can be taken to mitigate the hazard of suspension trauma, including trauma straps
on all fall gear, a fall protection plan for all work at heights that includes a rescue plan, and training
on the hazards within the use of fall protection equipment.

With greater knowledge of what suspension trauma is and how it affects the body, we can better plan
for the hazards and continue to improve the safety of our work.

References
1. "ANSI Z359.11 Safety Requirements for Full Body Harnesses" ANSI Z359 Fall Protection Code,
2007. Industrial Safety Standard.
2. http://www.asse.org/professionalaffairs/bosc/interviews/randall-wingfield2
3. https://www.osha.gov/dts/shib/shib032404.html
4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658225/